R. M. Dorman1,2, H. Naseem2, G. Ventro1,2, D. H. Rothstein1,2, K. Vali1,2 1State University Of New York At Buffalo,Department Of Surgery,Buffalo, NY, USA 2Women And Children’s Hospital Of Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA
Introduction: We sought to evaluate the impact of peri-operative ketorolac administration on outcomes in pediatric appendectomy.
Methods: The Pediatric Health Information System database was queried for patients aged 5-17 with a primary diagnosis of appendicitis and a primary procedure of appendectomy during the period 2010-2014. Patients with procedures suggesting incidental appendectomy, those records with data quality issues, deaths, and extra-corporeal membrane oxygenation (ECMO) were excluded. Variables recorded included age, sex, race, ethnicity, discharge year, complex chronic conditions (CCC), geographic region, intensive care unit admission, mechanical ventilation, and whether appendicitis was coded as complicated. The exposure variable was ketorolac administration on the day of or day after operation. The primary outcomes of interest were any surgical complications during the initial encounter, postoperative length of stay (LOS), total cost for the initial visit, any readmission to ambulatory, observation, or inpatient status within 30 days, and readmission with a diagnosis of peritoneal abscess or other postoperative infection or with transabdominal drainage performed.
Results: 78,926 were included in the analysis cohort. Mean age was 11.4 years (SD 3.3 years), the majority were male (61%), white (70%), and non-Hispanic (65%). Few had a CCC (3%) or required mechanical ventilation (2%) or an ICU admission (1%). Patients with complicated appendicitis comprised 28% of the cohort. Most (73%) received ketorolac on postoperative day 0-1; those with complicated appendicitis were less likely to receive ketorolac. In all, 2.6% of the cohort had a surgical complication during the index visit, 4.3% were readmitted within 30 days, and 2% had a post-operative infection or transabdominal drainage (1% in the uncomplicated group, 5% in the complicated group). Median post-operative LOS was 1 day and mean cost was $9,811 ± $9,509. On bivariate analysis, ketorolac administration was associated with a decrease in same-visit surgical complications (p=0.004) and cost ($459 decrease, p<0.001) but was not associated with readmission, post-operative LOS, or post-operative infection. On multivariate analysis, ketorolac administration was associated with a significant decrease in any complication (adjusted odd ratio 0.89, 95% C.I. 0.80-0.99) and cost (ANOVA p<0.001) but was not associated with readmission, post-operative LOS, or post-operative infection.
Conclusion: Based on a large, contemporary data set of children’s hospitals, ketorolac administration in the immediate post-operative period after appendectomy for appendicitis is common and was not associated with an increase in post-operative LOS, post-operative infection, or any-cause 30-day readmission. Ketorolac was, however, independently associated with a lower overall rate of post-operative complications and cost in this population.